Lecture 9: Principles of Onco Part 1 Flashcards
How many deaths is cancer responsible for in the US?
1 in 4 deaths ):
What # cause of death is cancer in the US?
1 is Tobacco
Second leading cause.
What are the 4 MC cancers?
Lung
Colon
Breast
Prostate
What are the top 3 MC cancers for males? Females?
Males:
Prostate
Lung/bronchus
Colorectal
Females:
Breast
Lung/bronchus
Colorectal
AKA lung and colorectal + gender-specific
What is the MC cancer to cause death in our age group?
Leukemia
Breast
What factors affect a person’s chance of developing cancer?
Exposure to certain environmental factors (diet, hormones)
Genetic makeup
Age/gender
What is cancer prevention concerned with?
Identification and manipulation of biologic, environmental, social, and genetic factors.
What is primary prevention?
Healthy lifestyle, designed to avoid ALL carcinogens.
What is the biggest factor in cancer susceptibility?
Environment!!
Genes play a minor role and are only for a few select cancers.
What is the most common PREVENTABLE cause of cancer death in the US?
Smoking tobacco
80% of lung cancers are associated with smoking tobacco.
What is adequate physical activity good at preventing cancer-wise?
Reduced risk of colon and breast cancer.
AKA gender-specific
At what BMI does cancer risk seem to start increasing significantly?
25
AKA overweight.
What kind of diets are associated with increased risk of breast, colon, prostate, and endometrium?
Diets high in fat.
Eating what in your diet is associated with a reduced risk of colonic polyps and colonic cancer?
Dietary fiber!
Cleaning the poop out = good
What does alcohol increase the risk of cancer-wise?
Mouth
Throat
Liver
Larynx
Esophagus
Stomach
Breast
What cancer is EBV most associated with?
Burkitt’s lymphoma
Nasal T cell lymphoma
BNE
What cancer is estrogen most associated with?
Endometrium
Liver
Breast
What cancer is ethyl alcohol most associated with?
Liver
Esophagus
Head and Neck
What cancer is H. pylori most associated with?
Gastric cancer
Gastric MALT lymphoma
What cancer is Hep B or C most associated with?
Liver
What cancer is UV sunlight most associated with?
Skin cancer
What cancer is tobacco most associated with?
Cancer of the upper aerodigestive tract
Bladder
What is secondary prevention concerned with?
Early detection and treatment.
Identifying people who are most at risk and implementing screening assessments for them.
What 4 things describe a screening test’s capability?
Sensitivity: # of people who test true positive in the screening.
Specificity: # of people who are true negatives in the screening.
PPV: # of people who are positive that have disease.
NPV: # of people who are negative that lack disease.
What cancers do we generally screen for routinely?
Cervical
Colon
Prostate
Breast
Lung (if at risk)
When are annual mammograms indicated?
Age 40
What is not recommended per USPSTF and ACS?
Clinical breast exams
Self breast exams
When does colorectal cancer screening begin?
Age 45
When does cervical cancer screening begin?
21
What is the mnemonic for warning signs of cancer?
CAUTION
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breasts, testes, etc.
Indigestion or difficulty swallowing
Obvious change in size/color of a mole
Nagging cough or hoarseness
What are some classical findings of cancer?
Nightsweats
Unexplained weight loss or loss of appetite
Persistent low-grade fever
Chronic pain
Persistent fatigue
What must be done to diagnose someone with cancer 100%?
An invasive tissue biopsy.
Non-invasive diagnostic tests are only suggestive.
What are the two components to diagnosing cancer?
Staging it
Monitoring it
What is staging?
Determining the extent of a disease, prognosis, and best treatment plan.
How common is depression in cancer pts?
25% incidence rate
What are some options we can treat with if a cancer pt becomes depressed?
SSRIs
Sertraline
Paroxetine
TCAs
What are the two types of staging?
Clinical staging
Pathologic staging
What tests are run for clinical staging?
PE
Radiographs
Isotopic scans
CT scans
What is involved in pathologic staging?
Palpation
Resection of lymph nodes
Inspection and biopsy.
Generally the info you obtain during a surgical procedure.
What is the first step in managing a cancer pt?
Determining the extent of the disease, aka staging it.
What is the common way to stage a cancer?
TNM
Tumor
Node
Metastasis
What is each component of TNM associated with?
Tumor is to check the size of the main tumor and if it has spread nearby.
Node is whether it has spread to regional lymph nodes.
Metastasis is whether it has spread beyond its region to other organs.
What kind of cancers cannot be staged by something like TNM?
Hematopoietic cancers, like leukemia or lymphoma.
What is physiologic reserve?
A patient’s likelihood of being able to cope with the physiologic stresses of cancer treatment.
What are some markers for physiologic reserve?
Age
Karnofsky performance status
Eastern cooperative oncology group performance status (ECOG)
How is Karnofsky performance status graded?
0-100, 100 being normal.
Has to do with ability to take care of oneself physically.
How is ECOG status graded?
Grade 0-5.
Grade 5 is dead.
Grade 4 is bedbound
What are the two goals of a treatment plan for cancer?
Curative
Palliative
What is the difference between remission and relapse?
Remission is lack of S/S of cancer.
Relapse is a return of S/S. Treating a relapse is called salvage therapy.
What is palliative care?
Improving quality of life.
Managing symptoms
No goal of curing the disease.
What are tumor markers mainly used for?
Determining a patient’s RESPONSE to treatment.
What cancer is HCG associated with?
Gestational trophoblastic disease, gonadal germ cell tumor.
Also in pregnancy.
What cancer is calcitonin associated with?
Medullary cancer of the thyroid
What cancer is alpha-fetoprotein associated with?
Hepatocellular carcinoma
Gonadal germ cell tumor.
What cancer is carcinoembryonic antigen (CEA) associated with?
Adenocarcinomas of the colon, pancreas, lung, breast, ovary
Also in pancreatitis, hepatitis, IBD, and smokers
What cancer is LDH associated with?
Lymphoma
Ewing’s sarcoma
Also in Hepatitis, hemolytic anemia, and many others.
What cancer is PSA associated with?
Prostate
Also in prostatitis and BPH
What is cancer is CA-125 associated with?
Ovarian cancer
Lymphomas
Also in menstruation, peritonitis, and pregnancy.
What cancer is CA 19-9 associated with?
COLON
Pancreatic
Breast
Also in pancreatitis and ulcerative colitis.
What tumor markers can be present in pregnancy?
HCG
CA-125
What tumor markers are specifically tumor-associated proteins?
PSA
CA-125
CA 19-9
What tumor marker is mainly for colon cancer?
CA 19-9
What is the biggest risk factor for cancer that we CANNOT modify?
Age
What is the most common cancer to cause death?
Lung cancer
What are the oncofetal antigens that are used as tumor markers?
Alpha fetoprotein
CEA
What enzyme is used as a tumor marker?
LDH
